Hospital General Universitario de Alicante, Servicio de Cirugía General y Aparato Digestivo, Alicante, Spain.
Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
Updates Surg. 2023 Jun;75(4):905-914. doi: 10.1007/s13304-023-01499-3. Epub 2023 Mar 29.
Laparoscopic cholecystectomy is the gold standard for the treatment of acute cholecystitis (AC). Percutaneous cholecystostomy (PC) for management of AC is increasing; safe and less invasive than laparoscopic cholecystectomy and is very useful in selected patients with severe comorbidities, not suitable for surgery/general anesthesia. We conducted a retrospective observational study between 2016 and 2021 of patients treated with PC for AC, based on the application of the Tokyo guidelines 13/18. The aim was to analyse the clinical results and management of PC in patients undergoing elective or emergency cholecystectomy. Subsequently, a retrospective analytical study was designed to compare various cohorts: elective or emergency surgery and management with PC alone; patients with/without a high surgical risk; and elective vs emergency surgery. Hundred and ninety five patients with AC were treated with PC. Mean age was 74 years, 59.5% were ASA class III/IV, and the mean Charlson comorbidity index was 5.5. Adherence to Tokyo guidelines regarding indication of PC was 50.8%. The rate of complications associated to PC was 12.3% and the 90-day mortality rate was 14.4%. Mean length of time using PC was 10.7 days. Emergency surgery was performed in 4.6%. The overall success rate using PC was 66.7%, and the 1-year readmission rate due to biliary complications after PC was 28.2%. The rate of scheduled cholecystectomy after PC was 22.6%. Conversion to laparotomy and open approach was more frequent in patients who underwent emergency surgery (p = 0.009). No differences were found in 90-day mortality or in the complication rate. PC achieves improvements in the inflammation and infection associated with AC. In our series, it proved to be an effective and safe treatment during the acute episode of AC. Mortality in patients treated with PC is high due to their older age, greater morbidity, and higher Charlson comorbidity index scores. After PC, emergency surgery is uncommon but readmission due to biliary events is high. Cholecystectomy after PC is the definitive treatment and the laparoscopic approach is feasible. Clinical trial registery: The study was registered in the public accessible database clinicaltrials.gov with the ClinicalTrials.gov ID: NCT05153031. Public release date: 12/09/2021.
腹腔镜胆囊切除术是治疗急性胆囊炎（AC）的金标准。经皮胆囊造口术（PC）用于 AC 的治疗正在增加；它比腹腔镜胆囊切除术更安全、创伤更小，并且在患有严重合并症、不适合手术/全身麻醉的选定患者中非常有用。我们对 2016 年至 2021 年期间根据东京指南 13/18 应用 PC 治疗 AC 的患者进行了回顾性观察研究。目的是分析接受择期或紧急胆囊切除术的 PC 患者的临床结果和处理方法。随后，设计了一项回顾性分析研究，比较了各种队列：择期或紧急手术以及单独使用 PC 的管理；有/无高手术风险的患者；以及择期与紧急手术。195 例 AC 患者接受了 PC 治疗。平均年龄为 74 岁，59.5%为 ASA 分级 III/IV 级，平均 Charlson 合并症指数为 5.5。PC 适应证符合东京指南的比例为 50.8%。与 PC 相关的并发症发生率为 12.3%，90 天死亡率为 14.4%。使用 PC 的平均时间为 10.7 天。紧急手术占 4.6%。PC 的总体成功率为 66.7%，PC 后因胆道并发症而再次入院的 1 年再入院率为 28.2%。PC 后行胆囊切除术的比例为 22.6%。行紧急手术的患者中转开腹的比例更高（p=0.009）。90 天死亡率或并发症发生率无差异。PC 可改善 AC 相关的炎症和感染。在我们的系列研究中，它在 AC 的急性发作期间被证明是一种有效且安全的治疗方法。由于患者年龄较大、合并症更多以及 Charlson 合并症指数评分较高，接受 PC 治疗的患者死亡率较高。PC 后，紧急手术并不常见，但因胆道事件再入院的比例较高。PC 后行胆囊切除术是明确的治疗方法，腹腔镜方法是可行的。临床试验注册处：该研究在公共可访问数据库 clinicaltrials.gov 中注册，注册号为 NCT05153031。公共发布日期：2021 年 9 月 12 日。
